Prevalence of food addiction determined by the Yale Food Addiction Scale and associated factors: A systematic review with meta-analysis

The burden of overweight/obesity and weight-related behaviors attributable to food addiction in emerging adults

While food addiction has been positively associated with excess weight and disordered eating behaviors, this has not been examined in representative samples of emerging adults, who are at elevated risk for these outcomes. This study investigated relationships of food addiction with weight outcomes, weight perception, and weight-control behaviors in emerging adults and estimated the population attributable fraction to food addiction. Data from an observational cohort study were collected in seven annual waves from 2010 to 2016. A nationally representative sample of 2785 10th grade students was recruited from schools within each U.S. census region (73% participation) (mean ± SD baseline age = 16.3 ± 0.5years). Wave 7 retention was 81% (n = 2323, 60% female, mean ± SD = 22.6 ± 0.5 years). Outcomes included current BMI, BMI change from baseline - wave 7, increased weight status in wave 7 (increased weight status from baseline-wave 7), perceived overweight, dieting, any weight-control behavior, and extreme weight-control behaviors. Food addiction was measured in wave 7 using the modified Yale Food Addiction Scale. Relative risk of the outcomes associated with food addiction, and population attributable fraction, were estimated using adjusted log-binomial or robust Poisson regression analyses accounting for the complex survey design. Food addiction prevalence was 4.7%. Participants with food addiction were primarily females (91%); food addiction was uncorrelated with other sociodemographics. Food addiction was associated with 48%-167% increased RR for all outcomes, but these were attenuated after adjustment for confounders (31%-64%). The population attributable fraction for food addiction ranged from 2% (high wave 7 BMI) - 5% (extreme weight-control behaviors). Although the population attributable fraction estimates indicate that the public health burden of these outcomes attributable to food addiction may be relatively minor, food addiction may signal the presence of several adverse mental health symptoms.

Early life adversity impacts alterations in brain structure and food addiction in individuals with high BMI

Obesity and food addiction are associated with distinct brain signatures related to reward processing, and early life adversity (ELA) also increases alterations in these same reward regions. However, the neural mechanisms underlying the effect of early life adversity on food addiction are unknown. Therefore, the aim of this study was to examine the interactions between ELA, food addiction, and brain morphometry in individuals with obesity. 114 participants with high body mass index (BMI) underwent structural MRIs, and completed several questionnaires (e.g., Yale Food Addiction Scale (YFAS), Brief Resilience Scale (BRS), Early Traumatic Inventory (ETI)). Freesurfer 6 was applied to generate the morphometry of brain regions. A multivariate pattern analysis was used to derive brain morphometry patterns associated with food addiction. General linear modeling and mediation analyses were conducted to examine the effects of ELA and resilience on food addiction in individuals with obesity. Statistical significance was determined at a level of p < 0.05. High levels of ELA showed a strong association between reward control brain signatures and food addiction (p = 0.03). Resilience positively mediated the effect of ELA on food addiction (B = 0.02, p = 0.038). Our findings suggest that food addiction is associated with brain signatures in motivation and reward processing regions indicative of dopaminergic dysregulation and inhibition of cognitive control regions. These mechanistic variabilities along with early life adversity suggest increased vulnerability to develop food addiction and obesity in adulthood, which can buffer by the neuroprotective effects of resilience, highlighting the value of incorporating cognitive appraisal into obesity therapeutic regimens.

The different areas of chronic stress and food addiction: Results from the LIFE-Adult-Study

There is an empirical association between stress and symptoms of food addiction (FA), but it is still not clear which domains of stress are the most relevant when it comes to FA, limiting the ability of researchers and practitioners to address problematic eating-related health outcomes. In order to address this gap in the literature, we analysed how different domains of chronic stress are related to FA. We used data from a subsample of the LIFE-Adult-Study (N = 1172), a German cohort study. We conducted a linear regression analysis with stress domains (Trier Inventory for Chronic Stress, TICS) as predictors of FA (Yale Food Addiction Scale, YFAS). In the second regression analysis we included sociodemographic variables, personality, and smoking as control variables. There was a significant and positive association between Social Overload, Work Discontent, Excessive Demands from Work, and Chronic Worrying and FA. After adding control variables, only Social Overload, Excessive Demands from Work, and Chronic Worrying remained significant predictors. Connections between stress domains and FA can serve as starting points for the development of meaningful interventions that support individuals self-care strategies (Social Overload), complexity management (Excessive Demands from Work), and coping with negative emotions (Chronic Worrying).

Ultra-Processed Food Addiction: A Research Update

PURPOSE OF REVIEW

Detail recent advancements in the science on ultra-processed food (UPF) addiction, focusing on estimated prevalence rates and emerging health disparities; progress towards identifying biological underpinnings and behavioral mechanisms; and implications for weight management.

RECENT FINDINGS

Notable developments in the field have included: (1) estimating the global prevalence of UPF addiction at 14% of adults and 15% of youths; (2) revealing health disparities for persons of color and those with food insecurity; (3) observing altered functioning across the brain-gut-microbiome axis; (4) providing early evidence for UPF withdrawal; and (5) elucidating poorer weight management outcomes among persons with UPF addiction. The breadth of recent work on UPF addiction illustrates continued scientific and public interest in the construct and its implications for understanding and treating overeating behaviors and obesity. One pressing gap is the lack of targeted interventions for UPF addiction, which may result in more optimal clinical outcomes for this underserved population.

Dismantling the myth of "all foods fit" in eating disorder treatment

We call for a reevaluation of the long-standing dogmatic nutritional principle that "all foods fit" for all cases of eating disorders (EDs) and its corollary, "there are no bad foods" (for anyone ever) during ED treatment. Based on accumulated scientific research, we challenge these ideologies as outdated, confusing, and potentially harmful to many patients. We review the evidence that indicates the folly of these assumptions and show there are a variety of exceptions to these rules, including (1) food allergies, sensitivities, and intolerances, (2) religious and spiritual preferences or doctrines, and (3) the ubiquitous emergence and widespread availability of ultra-processed foods leading to the potential development of addiction-like eating and a higher prevalence of various medical and psychiatric comorbidities, as well as higher mortality. This evidence supports a nutritional psychiatry approach that should be integrated into (rather than dissociated from) ED treatment research and practice.

On the prevalence of 'food addiction' in persons with bulimia nervosa

A meta-analysis by Praxedes and colleagues published in this journal reports that the prevalence of 'food addiction' as measured with the Yale Food Addiction Scale is lower than 50% in persons with bulimia nervosa and higher in persons with binge eating disorder. However, closely examining the supplementary material of that article reveals that these numbers cannot possibly be correct. Instead, most studies indicate that the prevalence of 'food addiction' is higher than 80% in persons with bulimia nervosa and, thus, higher than in persons with other eating disorders.

Type 2 diabetes mellitus is associated with food addiction in Brazilian women living in poverty

Food addiction (FA) has been widely investigated. For the first time, two studies reported its association with type 2 diabetes mellitus (DM2) in the general population and populations with mental disorders and undergoing bariatric surgery. However, the relationship between FA and DM2 needs to be better explored in different social contexts and population groups. Given this, the present study aims to evaluate whether DM2 diagnosis is associated with FA diagnosis in women living in poverty. This is a cross-sectional, population-based study conducted in a Brazilian capital city. FA was assessed by the modified Yale Food Addiction Scale (mYFAS) 2.0, and DM2 diagnosis was assessed by self-reporting of previous medical diagnosis. The association was assessed by multivariable Poisson regression with robust variance estimation adjusted for age, poverty situation, race/skin colour, physical activity and BMI. A total of 1878 women were included, of whom 15·1 % had FA and 3·2 % had a medical diagnosis of DM2. In the multivariable analysis, the medical diagnosis of DM2 was associated with FA (prevalence ratio, PR: 2·18; 95 % CI (1·26, 3·76)). The DM2 diagnosis was also identified to be associated with role interference (PR: 1·93; 95 % CI (1·01, 3·67)) symptom of FA. In conclusion, a positive association between FA and DM2 in women living in poverty was observed, information that adds to the current evidence already available in the literature, pointing to a new line of research and integrated care.

A three-arm randomised controlled trial of a telehealth intervention targeting improvement in addictive eating for Australian adults (the TRACE program)

There is a substantial research base for addictive eating with development of interventions. The current 3-arm RCT aimed to investigate the efficacy of the TRACE (Targeted Research for Addictive and Compulsive Eating) program to decrease addictive eating symptoms and improve mental health. Participants (18-85 yrs) endorsing ≥3 addictive eating symptoms were randomly allocated to 1) active intervention, 2) passive intervention, or 3) control group. Primary outcome was change in addictive eating symptoms 3-months post-baseline measured by the Yale Food Addiction Scale. Depression, anxiety and stress were also assessed. A total of 175 individuals were randomised. Using Linear Mixed Models, from baseline to 3-months, there was significant improvement in symptom scores in all groups with mean decrease of 4.7 (95% CI: -5.8, -3.6; p < 0.001), 3.8 (95% CI: -5.2, -2.4; p < 0.001) and 1.5 (95% CI: -2.6, -0.4; p = 0.01) respectively. Compared with the control group, participants in the active intervention were five times more likely to achieve a clinically significant change in symptom scores. There was a significant reduction in depression scores in the active and passive intervention groups, but not control group [-2.9 (95% CI: -4.5, -1.3); -2.3 (95% CI: -4.3, -0.3); 0.5 (95% CI: -1.1, 2.1), respectively]; a significant reduction in stress scores within the active group, but not passive intervention or control groups [-1.3 (95% CI: -2.2, -0.5); -1.0 (95% CI: -2.1, 0.1); 0.4 (95% CI: -0.5, 1.2), respectively]; and the reduction in anxiety scores over time was similar for all groups. A dietitian-led telehealth intervention for addictive eating in adults was more effective than a passive or control condition in reducing addictive eating scores from baseline to 6 months. Trial registration: Australia New Zealand Clinical Trial Registry ACTRN12621001079831.

The relationship between chronotype and food addiction: Serial mediation of social jetlag and psychological pain

This study evaluates how food addiction is related to chronotype, social jetlag, and psychological pain. Of the participants (n = 1,035 university students), 16.6% had a morning chronotype, 25.1% had an evening chronotype, and 25.1% were clinically addicted to eating. The mean sleep durations for participants were 7.41 ± 2.18 h and 8.95 ± 3.0 h on weekdays and weekends, respectively. The mean misalignment time for social jetlag was 1.45 ± 1.5 h. Food addiction, psychological pain, and social jetlag levels were high among participants with the evening chronotype. The risk factors for food addiction included being female, having an evening chronotype, and having high body mass index levels and psychological pain. The total indirect effect of psychological pain and social jetlag on the relationship between chronotype and food addiction was 20.6%. However, the social jetlag effect is relatively minor compared to psychological pain. The significant conclusions of this study are as follows. Clinical food addiction is prevalent among students, and a strong direct correlation between chronotype and food addiction was observed. The study emphasizes the importance of being aware of chronotype and mental status in establishing a healthy diet and lifestyle.

The qualitative evaluation of food addiction across the lifespan

Although it remains controversial, food addiction (FA) research has expanded substantially and empirical evidence for FA is growing. While quantitative studies have explored the prevalence and correlates of FA during childhood and adolescence, little is known about the perceived lived experience of FA across the lifespan, nor how experiences and perceptions of FA may change over time. For this study, 16 participants who met symptom threshold criteria for FA on the Yale Food Addiction Scale 2.0 completed in-depth, semi-structured qualitative interviews focused on their perceptions of the development of FA overtime, and perceived risk and protective factors. Thematic analysis was used to develop themes about the lived experience of FA in childhood, adolescence, and adulthood. Overall, highly palatable foods were viewed as the most problematic, while minimally processed foods were less associated with impairment and distress. Themes in childhood included a strong desire for highly processed foods and the perception that parental control over food choices could be either protective or risky for the later development of FA depending on which foods were available at home. In adolescence and young adulthood, increasing autonomy over food choices and the high availability of highly processed foods in the college environment were viewed as risk factors. Additionally, weight gain was a prominent theme. Finally, adulthood was characterized by more severe manifestations of FA, and the stress of adult responsibilities (e.g., work, parenting) contributed to this perception. This research sets the stage for future quantitative studies to explore these novel findings at the population level.

Co-occurrence of habit-forming risk behaviors and their socio-demographic, health status and lifestyle determinants: a population-based cross-sectional study

BACKGROUND

Although habit-forming risk behaviors frequently co-occur, determinants of concurrent risk behaviors have rarely been investigated. The aim of the present study was to investigate socio-demographic, health status, and lifestyle determinants of single versus concurrent risk behaviors in general-population adults.

METHODS

We analyzed data from 32,622 participants (74.5% female; mean age = 57.9 ± 14.2 years) of the NutriNet-Santé cohort who completed the Alcohol Use Disorders Identification Test, the 12-item Cigarette Dependence Scale, the modified Yale Food Addiction Scale 2.0, and the Internet Addiction Test in 2021-2022. Using established cutoffs, participants were first split into 2 groups (presence versus absence) for each risk variable (alcohol use disorders, nicotine dependence, food addiction, Internet addiction) and were then divided into 3 groups (no risk behavior, 1 risk behavior (reference), and ≥ 2 risk behaviors). The association between socio-demographic, health status, and lifestyle exposures and individual/concurrent risk behaviors were investigated with polytomous logistic regression.

RESULTS

Younger age (Odds Ratio (OR) = 2.04; 95% Confidence Interval (CI: 1.62-2.56), current financial difficulties (OR = 1.29; CI: 1.08-1.54), self-perceived poor health (OR = 1.70; CI: 1.32-2.20), overall poor dietary quality (OR = 2.88; CI: 2.06-4.02), being underweight (OR = 1.46; CI: 1.05-2.04), having obesity (OR = 1.62; CI: 1.31-1.99), lack of affection during childhood (OR = 1.41; CI: 1.18-1.69), and a lifetime prevalence or medication use for a mental disorder (OR = 1.46; CI: 1.24-1.73) were positively associated with having ≥ 2 versus 1 risk behavior (all p < 0.05). The comparison of none versus 1 risk behavior revealed the same determinants in addition to having a higher education, being physically active at work, and being overweight.

CONCLUSIONS

We investigated determinants of concurrent habit-forming risk behaviors among adults in a large, population-based study. The findings could serve as impetus for future research in this domain and ultimately help guide addiction prevention efforts.

Short-term effects of semaglutide among patients with obesity with and without food addiction: an observational study

INTRODUCTION

Food addiction (FA) is highly prevalent among people with obesity (PwO) and may constitute a key factor in weight loss failure or weight regain. GLP-1 analogues have been shown to act on the mesolimbic system, which is related to hedonic overeating and substance abuse. We aimed to study the effects of low doses of semaglutide on FA symptomatology and to evaluate whether the presence of FA have a negative impact on weight loss despite treatment with semaglutide.

METHODS

One hundred and thirteen PwO (45.5 ± 10.2 years) were evaluated anthropometrically baseline and after four months of treatment with semaglutide. PwO were evaluated for the presence of FA by completing The Spanish version of the Yale Food Addiction Scale 2.0 questionnaire (YFAS 2.0).

RESULTS

Baseline BMI and fat mass (%) were greater among PwO with FA (35.8 ± 4.5 vs 33 ± 3.9 kg/m2and 44.2 ± 6.5 vs 40.1 ± 7.9%; p = .01). After four months of treatment with semaglutide, the prevalence of FA diminished from 57.5% to 4.2% (p < .001). The percentage of weight loss (6.9 ± 12.7 vs 5.3 ± 4.6%; p = .4) and the proportion of fat mass loss (2 ± 9 vs 1.6 ± 3.1%; p = .7) were comparable between PwO with and without FA. No differences regarding side effects and treatment discontinuations were seen between the two groups.

CONCLUSION

Semaglutide is an effective tool for the amelioration of FA symptomatology among PwO. Despite PwO with FA had greater basal BMI and fat mass, semaglutide showed similar results compared to PwO without FA in terms of weight and fat mass loss at short term.

Independent associations of food addiction and binge eating measures with real-time eating behaviors and contextual factors: An exploratory ecological momentary assessment study

Food addiction (FA) is a concept centered around the addictive potential of highly palatable processed foods, though there is debate over the discriminative validity of FA as a distinct construct from binge-eating symptomatology. This study explored how trait measures of FA and binge-eating symptoms independently and interactively predicted eating behaviors and posited correlates of FA and binge eating measured via ecological momentary assessment (EMA). Adult participants (N = 49) who met the criteria for FA and/or binge-eating disorder completed baseline measures of FA (Yale Food Addiction Scale [YFAS 2.0]) and binge-eating symptoms (Eating Pathology Symptom Inventory [EPSI] binge eating scale) followed by a 10-day EMA protocol. Generalized linear mixed models examined the independent effects of YFAS 2.0, EPSI, and their interaction predicting EMA outcomes. Higher YFAS 2.0 symptom count scores were uniquely related to greater EMA-measured overeating, loss of control eating, negative and positive affect, and impulsivity when controlling for EPSI scores. Conversely, higher EPSI scores were uniquely related to greater EMA-measured eagerness and urge to eat, and expectancies that eating would improve mood. No interaction effects were significant. These results highlight potential distinctions between phenomena captured by FA and other measures of binge eating, in that FA symptoms may be a marker of heightened binge-eating severity, emotional arousal, and impulsivity.

The prevalence of hyperpalatable food intake among individuals with food addiction seeking bariatric surgery

INTRODUCTION

The prevalence of food addiction among patients seeking bariatric surgery is approximately 30 %. While hyper-palatable foods (HPF) have been identified as the potential 'substance' in food addiction and a contributor to severe obesity, consumption of HPF among individuals with food addiction, including those seeking bariatric surgery, is unknown. Thus, the aim of this study was to evaluate the consumption of HPF among individuals seeking bariatric surgery with food addiction, compared to those without food addiction.

METHODS

Participants were N = 54 individuals with severe obesity seeking bariatric surgery. The Yale Food Addiction Scale was used to identify individuals with food addiction (FA) (37 % of sample). Dietary recalls were used to quantify HPF intake. Analyses were conducted to characterize average HPF intake and to determine whether there were significant differences between HPF intake among those with FA compared to those without FA, and whether HFP intake was correlated with FA symptoms.

RESULTS

On average, 71 % of participants' daily calorie intake was from HPF. There were no significant differences in HPF items intake among individuals with and without FA (70.46 % vs 71.34; p = 0.85). A positive correlation between number of FA symptoms and the intake of HPF high in fat and sugar ([0.3]; p = 0.03) was observed.

CONCLUSION

In this pilot study, HPF consumption among individuals with and without FA seeking bariatric surgery was high overall, however there were no differences across groups. In addition, intake of HPF with fat and sugar was associated with the number of symptoms of food addiction. More studies with a larger sample are needed to confirm these preliminary findings.

Exploratory study of the prevalence of food addiction and its relationship with executive functioning, depression, and reinforcement sensitivity in a sample of Mexican adults

Introduction

The study of food addiction (FA) has become relevant due to its high prevalence, the negative impact on quality of life, and its association with neuropsychological and psychiatric symptoms. Several studies have provided scientific support for these associations, however, the results are contradictory. Additionally, studies have unsuccessfully elucidated the true nature of the failures in executive functioning in people with FA symptomatology, particularly when it comes to executive deficits. Therefore, the purpose of this research was to establish whether the presence of executive dysfunction, depressive symptoms and binge eating problems, as well as high reward sensitivity entails a greater severity in FA traits and high body mass index (BMI) in a sample of Mexican adults.

Methods

The sample consisted of Mexican men and women between 21-59 years (n = 36); who completed self-report questionnaires and performance tests to measure the study variables. Additionally, BMI was estimated with self-reported height and weight.

Results

Our results showed that a high number of FA symptoms were associated with higher executive dysfunction scores, greater reward sensitivity, and more severe depressive and binge eating problems. Furthermore, factors that are more strongly associated with higher scores of FA include severe executive deficits, greater activation of the punishment avoidance system, and persistence in the search for reward when the depressive symptoms increased. The factors that best explained changes in the estimated BMI of women were a decreased crystallized intellectual capacity and the inability to control food intake as the number of FA symptoms increased.

Discussion

In summary, the cognitive functioning profile characterized by general failure of the executive functioning, as well as a greater activation of the Punishment Avoidance System and persistence in the search for reward, were associated with greater severity of FA symptoms, especially when the depressive symptomatology was severe. In parallel, the psychopathology in participants associated with FA confirms the contribution of anxious and depressive symptomatology and borderline personality traits which could facilitate the expression of clinically relevant FA symptoms in women. Finally, we found that decreased crystallized intellectual capacity and inability to control food intake were linked to higher BMI when the number of FA symptoms increased.

Bariatric surgery and mental health outcomes: an umbrella review

Aims

To evaluate the breadth, depth and effectiveness of the evidence quality of all existing studies on bariatric surgery and mental health outcomes.

Design

Umbrella review of existing Systematic review and meta-analyses.

Data sources

PubMed, Embase, Web of Science, and the Cochrane Liberally databases of Systematic review and meta-analyses, and hand searching the reference lists of eligible publications.

Results

The search identified nine studies and 20 mental health outcomes from 1251 studies. Evidence shows that bariatric surgery is associated with significant improvement in areas such as anxiety, depression and eating disorders (including binge-eating disorder), and there is a significant harmful association with suicide, self-harm and alcohol use disorder (AUD). Among them, the most studied outcome is depression (4 articles). High-quality evidence proves that the score of depressive symptoms can be significantly improved after bariatric surgery within a two-year follow-up period and is not affected by the follow-up time. Low-quality evidence shows that bariatric surgery can significantly reduce depressive symptoms regardless of age and BMI, with an odds ratio (OR) of 0.49. Regardless of the postoperative BMI, the anxiety symptoms of women over 40 still decreased significantly, with an OR of 0.58. Regardless of the type of surgery, surgery can significantly reduce the incidence of eating disorders and symptoms. However, there is no obvious change in the follow-up time of AUD in the first two years after bariatric surgery, and the risk increases obviously in the third year, with an OR of 1.825. The evidence of moderate research shows that the risk of suicide and self-harm increases after bariatric surgery. The odds ratios in the same population and the control group were 1.9 and 3.8 times, respectively.

Conclusion

Bariatric surgery is beneficial for improving most mental health-related outcomes. However, we should be cautious about the increased risk of adverse mental health after surgery, such as suicide, self-harm, and AUD.

Features of Addiction in Binge-Eating Disorder: Considerations for Screening and Treatment

Similarities have been reported between the diagnostic and associated characteristics of binge-eating disorder (BED) and substance-related and non-substance-related disorders. This has resulted in interest in using addiction models to inform clinical care for people with BED. The purpose of this paper was to review features of addiction in BED with a focus on clinical implications. First, we briefly summarize similarities and differences in diagnostic and mechanistic features and symptoms for BED and food addiction, substance-related disorders, and non-substance-related disorders. Then we review aspects of addiction in BED that have clinical implications for screening and treatment of this condition. Similarities in diagnostic criteria between BED and substance-related and non-substance-related disorders include loss of control, greater use than intended, continued use despite adverse consequences, and marked distress. Addiction models may help inform aspects of clinical care of BED, particularly for shared antecedents and mechanisms underlying both disorders and to enhance engagement in treatment. Yet, there are large gaps in evidence regarding the effects of many aspects of addiction models to BED. More research is needed to examine the safety and efficacy of using addiction theories and frameworks for clinical strategies for BED.

Investigating gender differences in the co-occurrence of PTSD and food addiction

OBJECTIVE

Post-traumatic stress disorder (PTSD) commonly co-occurs with substance use disorders (SUDs). Past studies suggest PTSD is also associated with food addiction (compulsive intake of highly processed foods containing refined carbohydrates and/or added fat). However, research investigating gender differences has been limited (e.g., restricted samples) and mixed. We aim to investigate the risk of co-occurring PTSD and food addiction in a community sample for all participants and stratified by gender. Additionally, we conducted risk ratios for problematic substance use and obesity to allow for within-sample comparisons.

METHOD

We utilized a sample of 318 participants recruited from Amazon Mechanical Turk (mean age = 41.2, 47.8% men, 78.0% white) to address existing gaps in the literature on PTSD and food addiction. We calculated risk ratios (adjusted for sociodemographic covariates) using modified Poisson regression with 95% confidence intervals. Results were also gender stratified.

RESULTS

Risk of food addiction (Risk Ratio (RR) = 6.42, 95% CI [4.10, 10.07], problematic alcohol use (RR) = 3.86, 95% CI [2.25,6.62], problematic smoking (RR) = 3.93, 95% CI [2.22, 6.97], and problematic nicotine vaping (RR) = 5.41, 95% CI [2.41, 11.14] were higher for those meeting criteria for PTSD. Risk of problematic cannabis use, and risk of obesity were not significantly higher for those meeting criteria for PTSD. Gender-stratified results suggest risk of food addiction may be higher for men (RR) = 8.54, 95% CI [4.49, 16.25] compared to women (RR) = 4.32, 95% CI [2.16, 8.62].

DISCUSSION

Food addiction, but not obesity, appears to co-occur with PTSD more strongly than other types of problematic substance use (alcohol, cannabis, cigarettes, nicotine vaping). This risk appears to be particularly high for men compared to women. Assessing for food addiction in those with PTSD, particularly in men, may assist in identifying high-risk groups.

Prevalence and Correlates of Food Addiction in Bariatric Surgery Candidates and Its Effect on Bariatric Surgery Outcome: A Prospective Observational Study

PURPOSE

Studies have shown a high prevalence of food addiction (FA) in bariatric surgery candidates. This study examines prevalence of FA prior to and one year after bariatric surgery and the determinants of preoperative FA. Additionally, this study investigates how preoperative variables affect excess weight loss (EWL) one year after bariatric surgery.

MATERIALS AND METHODS

This prospective observational study included 102 patients at an obesity surgery clinic. Self-report measures, including demographic characteristics, the Yale Food Addiction Scale 2.0 (YFAS 2.0), the Depression Anxiety Stress Scale (DASS-21), and the Dutch Eating Behavior Questionnaire (DEBQ) were used two weeks before and one year after surgery.

RESULTS

The FA prevalence among bariatric surgery candidates decreased from 43.6% before surgery to 9.7% one year after surgery. Among independent variables, female gender and anxiety symptoms were associated with FA (OR = 4.20, 95% CI: 1.35-24.16, p = 0.028 and OR = 5.29, 95% CI: 1.49-18.81, p = 0.010, respectively). Only gender had a significant association with %EWL after surgery (p = 0.022); females had a higher mean %EWL than males.

CONCLUSION

FA is common among candidates for bariatric surgery, especially in women and participants with anxiety symptoms. The prevalence of FA, emotional eating, and external eating decreased after bariatric surgery.

Commentary on "Food addiction, orthorexia nervosa and dietary diversity among Bangladeshi university students: a large online survey during the COVID-19 pandemic"

The food addiction construct is receiving increasing attention from researchers and clinicians worldwide. Given its rise, scientific production on the subject is increasingly abundant. Conducting studies evaluating food addiction in emerging countries is of great importance, given that most scientific production comes from high-income countries. A recent study aimed to explore the prevalences of orthorexia nervosa and food addiction and their associations with dietary diversity in university students in Bangladesh during the COVID-19 pandemic. This correspondence presents questions about using the older version of the modified Yale Food Addiction Scale to assess food addiction. It also highlights issues related to the prevalence of food addiction observed in the study.

Association between food addiction with ultra-processed food consumption and eating patterns in a Brazilian sample

The study objectives were to determine whether consumption of ultra-processed foods (UPF) and eating patterns are associated with food addiction (FA) in a Brazilian sample. This is a cross-sectional study. The Brazilian Food and Nutrition Surveillance System tool assessed food consumption markers and dietary patterns. The modified Yale Food Addiction Scale 2.0 was used to determine FA. 5946 participants were included with a mean age of 24 ± 6 years, and 4371 (73.5%) were female. After statistical adjustments for confounders, individuals with FA had lower consumption of fresh fruits (PR: 0.88; 95%CI: [0.79; 0.97]), vegetables (PR: 0.87; 95%CI: [0.79; 0.97]), and beans (PR: 0.85; 95%CI: [0.77; 0.95]). They also had higher consumption of UPF: hamburgers/sausages (PR: 1.15; 95%CI: [1.04; 1.27]), instant noodles, packaged snacks, and/or salty cookies (PR: 1.27; 95%CI: [1.13; 1.42]), and sandwich cookies, sweets, and/or treats (PR: 1.26; 95%CI: [1.14; 1.40]). Positive associations between FA and having meals in front of the screen (PR: 1.48; 95%CI: [1.28; 1.71]) and having a late-night snack (PR: 1.24; 95%CI: [1.11; 1.39]) remained. The negative association between FA and skipping breakfast (PR: 0.76; 95%CI: [0.68; 0.85]) also remained. These eating patterns may contribute to FA, which could be potential targets for clinical intervention.

Food addiction and its relationship with other eating behaviours among Spanish university students

BACKGROUND

Food addiction (FA) is characterised by symptoms such as loss of control over food consumption, inability to reduce consumption despite the desire to do so, and continued consumption despite negative consequences. The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) is a widely used instrument to assess FA.

OBJECTIVES

To validate the Spanish mYFAS 2.0; to analyse the relationships between FA with other eating behaviours, sociodemographic variables, and Body Mass Index (BMI); and to test the eating-related variables that account for the variance in FA.

METHODS

The sample consisted of 400 university students (M_age = 24.16, SD_age = 6.12; 51% female), who completed the mYFAS 2.0 and measures of eating-related constructs.

RESULTS

A confirmatory factor analysis (CFA) supported the one-factor structure of the mYFAS 2.0. The scale showed good internal consistency (α = .78), and good convergent validity with the mYFAS. FA was related to eating styles, binge eating, and bulimia. No differences in FA were observed between males and females, and there was no association between FA and BMI. In addition, younger participants scored higher on FA than older participants. The eating-related variables explain 54.7% of the variance in FA.

CONCLUSIONS

The mYFAS 2.0 is a valid and reliable scale to assess FA in the Spanish population. The positive and significant relationship of variables related to eating (eating styles, binge eating and bulimia) with FA was demonstrated. These variables were indicated by those at high risk of FA.

Highly processed foods can be considered addictive substances based on established scientific criteria

BACKGROUND

There is growing evidence that an addictive-eating phenotype may exist. There is significant debate regarding whether highly processed foods (HPFs; foods with refined carbohydrates and/or added fats) are addictive. The lack of scientifically grounded criteria to evaluate the addictive nature of HPFs has hindered the resolution of this debate.

ANALYSIS

The most recent scientific debate regarding a substance's addictive potential centered around tobacco. In 1988, the Surgeon General issued a report identifying tobacco products as addictive based on three primary scientific criteria: their ability to (1) cause highly controlled or compulsive use, (2) cause psychoactive (i.e. mood-altering) effects via their effect on the brain and (3) reinforce behavior. Scientific advances have now identified the ability of tobacco products to (4) trigger strong urges or craving as another important indicator of addictive potential. Here, we propose that these four criteria provide scientifically valid benchmarks that can be used to evaluate the addictiveness of HPFs. Then, we review the evidence regarding whether HPFs meet each criterion. Finally, we consider the implications of labeling HPFs as addictive.

CONCLUSION

Highly processed foods (HPFs) can meet the criteria to be labeled as addictive substances using the standards set for tobacco products. The addictive potential of HPFs may be a key factor contributing to the high public health costs associated with a food environment dominated by cheap, accessible and heavily marketed HPFs.

Dissociative experiences of compartmentalization are associated with food addiction symptoms: results from a cross-sectional report

PURPOSE

Studies have shown significant associations of dissociative symptoms with both eating and addictive disorders; however, the different forms of dissociation have been relatively understudied in relation to food addiction (FA). The main aim of this study was to investigate the association of certain forms of dissociative experiences (i.e., absorption, detachment and compartmentalization) with FA symptoms in a nonclinical sample.

METHODS

Participants (N = 755; 543 women; age range: 18-65; mean age: 28.22 ± 9.99 years) were evaluated using self-report measures of FA, dissociation, eating disturbances, and general psychopathology.

RESULTS

Compartmentalization experiences (defined as pathological over-segregation of higher mental functions) were independently associated with FA symptoms (β = 0.174; p = 0.013; CI = [0.008; 0.064]) even when confounding factors were controlled for.

CONCLUSION

This finding suggests that compartmentalization symptoms can have a role in the conceptualization of FA, with such two phenomena possibly sharing common pathogenic processes.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Prevalence of food addiction determined by the Yale Food Addiction Scale in Latin America: A systematic review with meta-analysis

OBJECTIVE

Food addiction (FA) has been extensively investigated worldwide; however, the prevalence of FA in the Latin American population has yet to be established and past work has largely neglected the specificities of this region, that includes the most significant economic disparities in the world. Thus, the objective of this study was to assess the prevalence of FA measured by the Yale Food Addiction Scale in Latin America.

METHOD

The search was performed on MEDLINE, ScienceDirect, LILACS, IBECS, SciELO, PsycArticles, CENTRAL, and the gray literature. FA prevalence data were collected, and random effects meta-analyses were performed to calculate the overall weighted prevalence, the prevalence by country, and by clinical and non-clinical samples.

RESULTS

A total of 10,082 occurrences were identified through database searches, and 23 studies were included (Mexico = 9; Brazil = 7; Chile = 4; Argentina = 1; Peru = 1; Uruguay = 1). The prevalence of FA found in clinical samples was 38% (95% CI: 16%-63%; I²  = 98.67%; 8 studies), while in non-clinical samples, it was 15% (95% CI: 10%-21%; I²  = 98.51%; 15 studies).

DISCUSSION

The average prevalence of FA in the Latin American countries included here was in accordance with that reported in other regions worldwide. It is noteworthy that the studies were conducted only in six countries, which are among those with the highest income in the region and do not represent the situation in native populations or those with lower purchasing power. This gap in the data also reflects the effects of economic disparities on the availability of empirical data in the region.

PUBLIC SIGNIFICANCE

The prevalence of food addiction in Latin America was similar to that reported in other regions. It was higher among individuals with overweight, whether or not undergoing bariatric surgery, than in non-clinical samples. These findings contribute to aggregate information about this condition that has drawn the attention of clinicians and researchers.

Prevalence of food addiction among patients undergoing metabolic/bariatric surgery: A systematic review and meta-analysis

Candidates for metabolic/bariatric surgery show a high prevalence of food addiction (FA). However, few studies have investigated FA prevalence after bariatric surgery, especially using longitudinal studies. This systematic review with a meta-analysis aimed to determine pre- and postoperative prevalence of FA among patients undergoing metabolic/bariatric surgery. It included both cross-sectional and longitudinal studies that used the Yale Food Addiction Scale (YFAS). The following databases were searched: MEDLINE, ScienceDirect, LILACS, PsycArticles, CENTRAL, greylit.org, and opengrey.eu. Studies that used the YFAS to evaluate FA in pre- or postoperative patients were included. A random-effects meta-analysis was performed with cross-sectional studies to calculate the weighted prevalence of FA at the pre- and postoperative moments. For longitudinal studies, which measured FA at both time points for the same individuals, absolute prevalence reduction (APR) was calculated. Of the 6626 records, 40 studies were included in the meta-analysis. The preoperative weighted prevalence of FA was 32% (95% CI: 27-37%; 33 groups), whereas the postoperative prevalence was 15% (95% CI: 12-18%; 14 groups). Seven longitudinal studies showed a weighted APR of 26 p.p. (95% CI: 10-41 p.p.). Observational data suggest a reduction in the prevalence of FA among patients that undergo bariatric surgery. Interventional studies are needed to confirm these findings.

Prediction of body fat increase from food addiction scale in school-aged children and adolescents: A longitudinal cross-lagged study

Objective

Food addiction (FA) is associated with a higher body mass index z-score (BMIZ) in children and adolescents; however, whether these two aspects evolve interdependently remains unknown. This study aimed to address this question using a cross-lagged study.

Methods

Weight status, including BMIZ, fat content (FC), and visceral fat level (VFL), was determined in 880 children and adolescents (mean age = 14.02 years [range = 8.83-17.52 years]) at two-time points with an interval of 6 months. FA was characterized using the Chinese version of the dimensional Yale Food Addiction Scale for Children 2.0. Furthermore, FC and VFL were measured using direct segmental multi-frequency bioelectrical impedance analysis at each time point.

Results

Higher FA was associated with increased BMIZ, FC, and VFL (P < 0.05). FA at T0 could predict increased FC at T1 (P < 0.05). The characteristics of females, primary students, and living in urban areas may aggravate the adverse effect of FA on weight status over time and age, particularly the increased VFL in participants aged > 14 years.

Conclusion

Children and adolescents with a high FA level were at risk for weight gain attributed to increased FC, and the adverse effect could be aggravated with time and age. Novel FA-targeting interventions may help mitigate the risk of getting obesity.

Socio-Demographic, Self-Control, Bullying, Parenting, and Sleep as Proximal Factors Associated with Food Addiction among Adolescents

Adolescence is considered an important period of neurodevelopment. It is a time for the emergence of psychosocial vulnerabilities, including symptoms of depression, eating disorders, and increased engagement in unhealthy eating behaviours. Food addiction (FA) in adolescents is an area of study where there has been substantial growth. However, to date, limited studies have considered what demographic characteristics of adolescents may predispose them to endorse greater symptoms of FA. Studies have found a variety of factors that often cluster with and may influence an adolescent's eating behaviour such as sleep, level of self-control, and parenting practices, as well as bullying. Therefore, this study investigated a range of socio-demographic, trait, mental health, and lifestyle-related profiles (including self-control, parenting, bullying, and sleep) as proximal factors associated with symptoms of FA, as assessed via the Yale Food Addiction Scale for Children (YFAS-C) in a large sample of Australian adolescents. Following data cleaning, the final analysed sample included 6587 students (age 12.9 years ± 0.39; range 10.9-14.9 years), with 50.05% identifying as male (n = 3297), 48.5% as female (n = 3195), 1.02% prefer not to say (n = 67), and 0.43% as non-binary (n = 28). Self-control was found to be the most significant predictor of total FA symptom score, followed by female gender, sleep quality, and being a victim of bullying. Universal prevention programs should therefore aim to address these factors to help reduce the prevalence or severity of FA symptoms within early adolescent populations.

The Yale Food Addiction Scale 2.0 and the modified Yale Food Addiction Scale 2.0 in Taiwan: Factor structure and concurrent validity

Introduction

The most widely used instruments to assess food addiction - the Yale Food Addiction Scale 2.0 (YFAS 2.0) and its modified version (mYFAS 2.0) - have not been validated in a Taiwanese population. The present study compared the psychometric properties between the Taiwan versions of YFAS 2.0 and mYFAS 2.0 among university students.

Methods

An online survey comprising the YFAS 2.0, mYFAS 2.0, Weight Self-Stigma Questionnaire (WSSQ) and International Physical Activity Questionnaire-Short Form (IPAQ-SF) were used to assess food addiction, self-stigma, and physical activity.

Results

All participants (n = 687; mean age = 24.00 years [SD ± 4.48 years]; 407 females [59.2%]) completed the entire survey at baseline and then completed the YFAS 2.0 and mYFAS 2.0 again three months later. The results of confirmatory factor analysis (CFA) indicated that the YFAS 2.0 and mYFAS 2.0 both shared a similar single-factor solution. In addition, both the YFAS 2.0 and mYFAS 2.0 reported good internal consistency (Cronbach's α = 0.90 and 0.89), good test-retest reliability (ICC = 0.71 and 0.69), and good concurrent validity with the total scores being strongly associated with the WSSQ (r = 0.54 and 0.57; p < 0.01), and less strongly associated with BMI (r = 0.17 and 0.13; p < 0.01) and IPAQ-SF (r = 0.23 and 0.25; p < 0.01).

Discussion

Based on the findings, the Taiwan versions of the YFAS 2.0 and mYFAS 2.0 appear to be valid and reliable instruments assessing food addiction.

Food Addiction Problems in College Students: The Relationship between Weight-Related Variables, Eating Habits, and Food Choices

The concept of food addiction, characterized by a strong urge to overeat highly palatable foods, has gained increased research attention over the last decade. College students are a recognized risk group for manifesting an eating pathology and weight gain due to the changes in eating habits experienced during this period. However, there is a gap in the literature connecting food addiction with eating and weight variables in this population. Thus, the present study aims to characterize food addiction in a sample of college students and enlighten the relationship between food addiction, weight-variables, eating habits, and food choices in this population. A sample of 194 college students (89.2% females) aged between 18 and 32 years old (M = 20.85, SD = 2.78) completed a set of self-reported online questionnaires on Google Forms. Namely, a Sociodemographic and Anthropometric Questionnaire, a questionnaire on Food Choices Characterization, the Eating Habits Scale, and the Portuguese Yale Food Addiction Scale 2.0. Thirty (22.2%) participants presented food addiction problems. The logistic regression models utilized suggest that participants in the group with food addiction problems are more likely to seek clinical help to control weight, to consider that they should eat less food high in sugar, and to report lower food adequacy. In sum, this finding highlighted a connection between food addiction, weight dissatisfaction, eating habits, and food choices in college students, a population at risk for developing and retaining eating pathologies. Further research is essential to evaluate and implement interventions regarding food addiction, weight dissatisfaction, eating habits, and food choices in college students.

Associations Between Food Addiction and Substance-Use Disorders: A Critical Overview of their Overlapping Patterns of Consumption

Purpose of Review

Research on patterns of overconsumption in individuals with food addiction (FA) has focused largely on binge eating. However, compulsive overeating can be varied and dimensional. This review focuses on the similarities between the patterns of consumption in FA and in other clinically established substance-use disorders, such as alcohol and nicotine dependence. It also highlights features that make FA unique to other addiction disorders.

Recent Findings

Overall, there is substantial evidence that binge-like overconsumption is a characteristic of various substance-use and eating disorders. Likewise, it appears that different overeating patterns can reflect addictive-like eating. One pattern may be compulsive grazing — defined as the repetitive inability to resist consumption of small amounts of food.

Summary

This review adds to the increasingly compelling picture that FA and binge-eating disorder are unique conditions, and that FA resembles other substance-use disorders. We conclude that a variety of overeating patterns can reflect addictive eating behaviours in vulnerable individuals, one of which may be compulsive grazing.

Understanding eating behaviours, mental health and weight change in young adults: protocol paper for an international longitudinal study

INTRODUCTION

Understanding the complexities of change in eating behaviours, mental health, well-being and weight is crucial to inform healthcare and service provision, particularly in light of the exacerbating effects of the COVID-19 pandemic. This study aims to address the need for more comprehensive cross-sectional and longitudinal evidence, by tracking eating behaviours, mental health, health related behaviours and weight over a 12-month period, in a sample of young adults (18-35 years) in the UK and Australia.

METHODS AND ANALYSIS

Online surveys administered via the Prolific online research platform will be used for data collection at baseline, 6 months and 12 months. The survey (approximately 45 min) measures demographics, the impact of COVID-19, body mass index (BMI), weight management and health service usage, eating behaviours, personality, mental health, and health-related behaviours. An optional substudy component at each time point aims to validate self-reported weight in the main survey through images. Study inclusion criteria are; aged 18-34 years at baseline, BMI ≥20 kg/m², and residing in the UK or Australia. A target of 500 participants at baseline was set, recruited through Prolific, and with recruitment stratified by BMI, sex and country. The proposed analyses include creating static predictive models using baseline data (eg, using latent class analysis, factor analysis or similar), and mapping changes longitudinally (eg, using multivariate regressions). These analyses will enable changes in the study measures to be identified, as well as predictors and outcomes of change.

ETHICS AND DISSEMINATION

Ethical approval was granted by Leeds Beckett University, UK (reference number 86004) and the University of Newcastle, Australia (reference number H-2022-0110). Study findings will be disseminated through scientific journals, conferences, institute websites and social media, and briefings tailored to policy, practice and the public, with the intention to help inform the future development of health and well-being care and support for young adults across Australia and the UK.

Food Addiction: a Deep Dive into ‘Loss of Control’ and ‘Craving’

Purpose of Review

The majority of existing research discusses food addiction (FA) classification, which provides information for different groups and which groups may or may not be affected to differing degrees. Fewer studies report FA symptom scores, and fewer still report on individual symptoms. This paper discusses the symptoms of craving and loss of control as they are common FA symptoms that demonstrate similarities with both substance use disorders and some eating disorder pathology.

Recent Findings

Loss of control presents parallels with disordered eating, particularly binge eating disorder. Craving refers to the powerful or strong desire for something and, in contrast to lack of control, presents most overlap with substance use disorders.

Summary

While not the most common symptoms reported in published research, loss of control and craving attract attention because of parallels with substance use and eating disorder pathology, and research has increasingly focused on these symptoms in recent years.

Childhood trauma and food addiction: The role of emotion regulation difficulties and gender differences

OBJECTIVE

Childhood trauma has been associated with substance use disorders (SUDs), but less research has investigated its association with food addiction (i.e., compulsive intake of highly processed foods containing refined carbohydrates and/or added fat). Existing research on childhood trauma and food addiction has focused primarily on women from restricted samples. Further, emotion dysregulation difficulties are implicated in both childhood trauma and food addiction, but research has not explored whether it may play a mediating role.

METHOD

Thus, the current study utilizes a sample of 310 participants recruited from Amazon Mechanical Turk (mean age = 41.3 years old, 47.4% men, 78.7% white) to investigate the mediating role of emotion dysregulation in the association between childhood trauma and food addiction. We also conducted exploratory analyses to investigate for gender differences in these associations. Gender-stratified correlational matrixes were conducted to investigate association between childhood trauma, food addiction, and emotional dysregulation. Moderated mediation models and multilevel regressions were also conducted to identify the role of gender in the association between childhood trauma, food addiction, and emotion dysregulation.

RESULTS

Emotion dysregulation was found to partially mediate the associations between food addiction and childhood trauma and gender was found to moderate associations between childhood trauma and emotion dysregulation, as well as childhood trauma and food addiction. Both moderating pathways were significantly stronger for men compared to women.

DISCUSSION

Results suggests that emotion dysregulation may be one important mediator in the association between childhood trauma and food addiction, particularly for men. The identification of other potential mechanisms contributing to the association between childhood trauma and food addiction and the use of longitudinal measurement strategies will be important in future research.

Clinical Considerations of Ultra-processed Food Addiction Across Weight Classes: an Eating Disorder Treatment and Care Perspective

Purpose of Review

To examine the prevalence rates of ultra-processed food addiction across different weight classes and offer guidelines for diagnosis and treatment. Clinicians are provided with practical considerations in the assessment of ultra-processed food addiction beyond the use of validated instruments.

Recent Findings

The weighted mean prevalence of ultra-processed food addiction is approximately 20% worldwide and varies widely based on the sample. At first glance, there appears a linear relationship between ultra-processed food addiction and BMI class. Further investigation indicates a J-shaped curve with heightened prevalence among the underweight. These findings highlight the need to assess for additional factors that may increase objective or subjective food addiction symptoms including eating disorders, dietary restraint, and other mental health diagnoses.

Summary

While clinical considerations across different weight classes vary, overemphasis on weight status may detract from the clinical utility of the ultra-processed food addiction construct. Considering weight status in conjunction with other psychiatric symptoms helps to better understand the various biopsychosocial mechanisms that influence eating behavior and can inform individualized treatment strategies.

Low carbohydrate and psychoeducational programs show promise for the treatment of ultra-processed food addiction

Food addiction, specifically ultra-processed food addiction, has been discussed in thousands of peer-reviewed publications. Although 20% of adults meet criteria for this condition, food addiction is not a recognized clinical diagnosis, leading to a dearth of tested treatment protocols and published outcome data. Growing numbers of clinicians are offering services to individuals on the basis that the food addiction construct has clinical utility. This audit reports on clinical teams across three locations offering a common approach to programs delivered online. Each team focused on a whole food low-carbohydrate approach along with delivering educational materials and psychosocial support relating to food addiction recovery. The programs involved weekly sessions for 10-14 weeks, followed by monthly support. The data comprised pre- and post- program outcomes relating to food addiction symptoms measured by the modified Yale Food Addiction Scale 2.0, ICD-10 symptoms of food related substance use disorder (CRAVED), mental wellbeing as measured by the short version of the Warwick Edinburgh Mental Wellbeing Scale, and body weight. Sample size across programs was 103 participants. Food addiction symptoms were significantly reduced across settings; mYFAS2 score -1.52 (95% CI: -2.22, -0.81), CRAVED score -1.53 (95% CI: -1.93, -1.13) and body weight was reduced -2.34 kg (95% CI: -4.02, -0.66). Mental wellbeing showed significant improvements across all settings; short version Warwick Edinburgh Mental Wellbeing Scale 2.37 (95% CI: 1.55, 3.19). Follow-up data will be published in due course. Further research is needed to evaluate and compare long-term interventions for this complex and increasingly burdensome biopsychosocial condition.